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      Six-lead electrocardiography compared to single-lead electrocardiography and photoplethysmography of a wrist-worn device for atrial fibrillation detection controlled by premature atrial or ventricular contractions: six is smarter than one

      research-article
      Author(s): 1 , 2 , * , , 1 , 2 , 1 , 2 , 3 , 3 , 1 , 1 , 2 , 1 , 1 , 2 , 1 , 2 , 1 , 2 , 1 , 2 , 1 , 2 , 1 , 2 , 1 , 2 , 1 , 2 , 1 , 2 , 1 , 1 , 2 , 1 , 2 , 1 , 1 , 1 , 2 , 4 , 5 , 3 , 6 , 1 , 2
      Publication date (Electronic):
      Journal: Frontiers in Cardiovascular Medicine
      Publisher: Frontiers Media S.A.
      Keywords: wearable, smartWatch, multiple-lead ECG, telemedicine, mHealth, remote monitoring, digital

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          Abstract

          Background

          Smartwatches are commonly capable to record a lead-I-like electrocardiogram (ECG) and perform a photoplethysmography (PPG)-based atrial fibrillation (AF) detection. Wearable technologies repeatedly face the challenge of frequent premature beats, particularly in target populations for screening of AF.

          Objective

          To investigate the potential diagnostic benefit of six-lead ECG compared to single-lead ECG and PPG-based algorithm for AF detection of the wrist-worn device.

          Methods and results

          From the database of DoubleCheck-AF 249 adults were enrolled in AF group ( n = 121) or control group of SR with frequent premature ventricular (PVCs) or atrial (PACs) contractions ( n = 128). Cardiac rhythm was monitored using a wrist-worn device capable of recording continuous PPG and simultaneous intermittent six-lead standard-limb-like ECG. To display a single-lead ECG, the six-lead ECGs were trimmed to lead-I-like ECGs. Two diagnosis-blinded cardiologists evaluated reference, six-lead and single-lead ECGs as “AF”, “SR”, or “Cannot be concluded”. AF detection based on six-lead ECG, single-lead ECG, and PPG yielded a sensitivity of 99.2%, 95.7%, and 94.2%, respectively. The higher number of premature beats per minute was associated with false positive outcomes of single-lead ECG (18.80 vs. 5.40 beats/min, P < 0.01), six-lead ECG (64.3 vs. 5.8 beats/min, P = 0.018), and PPG-based detector (13.20 vs. 5.60 beats/min, P = 0.05). Single-lead ECG required 3.4 times fewer extrasystoles than six-lead ECG to result in a false positive outcome. In a control subgroup of PACs, the specificity of six-lead ECG, single-lead ECG, and PPG dropped to 95%, 83.8%, and 90%, respectively. The diagnostic value of single-lead ECG (AUC 0.898) was inferior to six-lead ECG (AUC 0.971) and PPG-based detector (AUC 0.921). In a control subgroup of PVCs, the specificity of six-lead ECG, single-lead ECG, and PPG was 100%, 96.4%, and 96.6%, respectively. The diagnostic value of single-lead ECG (AUC 0.961) was inferior to six-lead ECG (AUC 0.996) and non-inferior to PPG-based detector (AUC 0.954).

          Conclusions

          A six-lead wearable-recorded ECG demonstrated the superior diagnostic value of AF detection compared to a single-lead ECG and PPG-based AF detection. The risk of type I error due to the widespread use of smartwatch-enabled single-lead ECGs in populations with frequent premature beats is significant.

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          Most cited references24

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            Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge

            Giuseppe Lippi, Fabian Sanchis-Gomar, Gianfranco Cervellin (2020)
            Atrial fibrillation is the most frequent cardiac arrhythmia. It has been estimated that 6–12 million people worldwide will suffer this condition in the US by 2050 and 17.9 million people in Europe by 2060. Atrial fibrillation is a major risk factor for ischemic stroke and provokes important economic burden along with significant morbidity and mortality. We provide here comprehensive and updated statistics on worldwide epidemiology of atrial fibrillation. An electronic search was conducted for atrial fibrillation. The epidemiologic information was retrieved from the Global Health Data Exchange database, which is regarded as one of the most comprehensive worldwide catalogs of surveys, censuses, vital statistics, and other health-related data. A total of 3.046 million new cases of atrial fibrillation worldwide were registered in the database during 2017. The estimated incidence rate for 2017 (403/millions inhabitants) was 31% higher than the corresponding incidence in 1997. The worldwide prevalence of atrial fibrillation is 37,574 million cases (0.51% of worldwide population), increased also by 33% during the last 20 years. The highest burden is seen in countries with high socio-demographic index, though the largest recent increased occurred in middle socio-demographic index countries. Future projections suggest that absolute atrial fibrillation burden may increase by >60% in 2050. Our analyses suggest that atrial fibrillation incidence and prevalence have increased over the last 20 years and will continue to increase over the next 30 years, especially in countries with middle socio-demographic index, becoming one of the largest epidemics and public health challenges.
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              Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis

              Ayodele Odutayo, Christopher X Wong, Allan Hsiao … (2016)
              Article 0 comments Cited 135 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Justinas Bacevicius: URI : https://loop.frontiersin.org/people/1644546/overview
                Neringa Taparauskaite: URI : https://loop.frontiersin.org/people/2222192/overview
                Daivaras Sokas: URI : https://loop.frontiersin.org/people/1330732/overview
                Monika Butkuviene: URI : https://loop.frontiersin.org/people/1730105/overview
                Guoste Stankeviciute: URI : https://loop.frontiersin.org/people/2331554/overview
                Zygimantas Abramikas: URI : https://loop.frontiersin.org/people/1726972/overview
                Aiste Pilkiene: URI : https://loop.frontiersin.org/people/2331662/overview
                Ernestas Dvinelis: URI : https://loop.frontiersin.org/people/1726974/overview
                Justina Staigyte: URI : https://loop.frontiersin.org/people/1727658/overview
                Julija Marinskiene: URI : https://loop.frontiersin.org/people/1729578/overview
                Deimile Audzijoniene: URI : https://loop.frontiersin.org/people/1727595/overview
                Marija Petrylaite: URI : https://loop.frontiersin.org/people/1727580/overview
                Albinas Karuzas: URI : https://loop.frontiersin.org/people/1743913/overview
                Vytautas Juknevicius: URI : https://loop.frontiersin.org/people/1727030/overview
                Rusne Jakaite: URI : https://loop.frontiersin.org/people/1727211/overview
                Viktorija Basyte-Bacevice: URI : https://loop.frontiersin.org/people/1729574/overview
                Ignas Badaras: URI : https://loop.frontiersin.org/people/2331662/overview
                Gintare Zarembaite: URI : https://loop.frontiersin.org/people/2325387/overview
                Eugenijus Jasiunas: URI : https://loop.frontiersin.org/people/1727000/overview
                Linda Johnson: URI : https://loop.frontiersin.org/people/1570652/overview
                Vaidotas Marozas: URI : https://loop.frontiersin.org/people/774114/overview
                Audrius Aidietis: URI : https://loop.frontiersin.org/people/1727076/overview
                Journal
                Journal ID (nlm-ta): Front Cardiovasc Med
                Journal ID (iso-abbrev): Front Cardiovasc Med
                Journal ID (publisher-id): Front. Cardiovasc. Med.
                Title: Frontiers in Cardiovascular Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2297-055X
                Publication date (Electronic): 09 June 2023
                Publication date Collection: 2023
                Volume: 10
                Electronic Location Identifier: 1160242
                Affiliations
                [ 1 ]Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius, Lithuania
                [ 2 ]Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos , Vilnius, Lithuania
                [ 3 ]Biomedical Engineering Institute, Kaunas University of Technology , Kaunas, Lithuania
                [ 4 ]Center of Informatics and Development, Vilnius University Hospital Santaros Klinikos , Vilnius, Lithuania
                [ 5 ]Department of Clinical Sciences, Malmö, Lund University , Lund, Sweden
                [ 6 ]Electronics Engineering Department, Kaunas University of Technology , Kaunas, Lithuania
                Author notes

                Edited by: Dominik Linz, Maastricht University Medical Centre, Netherlands

                Reviewed by: Laurent Pison, East Limburg Hospital, Belgium David Zweiker, Klinik Ottakring, Austria

                [* ] Correspondence: Justinas Bacevicius justinas.bacevicius100@ 123456gmail.com
                Article
                DOI: 10.3389/fcvm.2023.1160242
                PMC ID: 10288196
                SO-VID: f7cdb9f4-7c65-43b6-9981-2e2b0a316e18
                Copyright © © 2023 Bacevicius, Taparauskaite, Kundelis, Sokas, Butkuviene, Stankeviciute, Abramikas, Pilkiene, Dvinelis, Staigyte, Marinskiene, Audzijoniene, Petrylaite, Jukna, Karuzas, Juknevicius, Jakaite, Basyte-Bacevice, Bileisiene, Badaras, Kiseliute, Zarembaite, Gudauskas, Jasiunas, Johnson, Marozas and Aidietis.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 06 February 2023
                Date accepted : 26 May 2023
                Page count
                Figures: 9, Tables: 2, Equations: 0, References: 24, Pages: 0, Words: 0
                Funding
                Funded by: European Regional Development Fund
                Award ID:  
                Funded by: Research Council of Lithuania
                Award ID:  
                This work was supported by the European Regional Development Fund (01.2.2-LMT-K-718-03-0027) under grant agreement with the Research Council of Lithuania (LMTLT).
                Categories
                Subject: Cardiovascular Medicine
                Subject: Original Research
                Custom metadata
                section-at-acceptance Cardiac Rhythmology

                Keywords: wearable,smartwatch,multiple-lead ecg,telemedicine,mhealth,remote monitoring,digital
                Data availability:
                Keywords: wearable, smartwatch, multiple-lead ecg, telemedicine, mhealth, remote monitoring, digital

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